Night Anxiety: Causes, Consequences and How to Overcome It

1 April, 2021
This article has been written and endorsed by la psicóloga Laura Ruiz Mitjana
Nocturnal anxiety, as its name suggests, is one that appears at night. How does it manifest itself and what are its possible causes? How can we combat it?

Anxiety disorders, along with depressive disorders, are one of the most prevalent mental disorders in the world. Many people suffer from anxiety during the day, but what about at night? There’s evidence to suggest that it’s quite prevalent. For that reason, we’re going to talk about night anxiety in this article.

Night anxiety appears just when we go to bed or even in the middle of the night (which can wake us out of our sleep). When it happens in the middle of the night, it’s usually a nocturnal panic attack, or an overactivation of certain areas of our body.

A person who suffers night anxiety (just as those who suffer from it during the day) feels nervous, hyperactive, irritable, with symptoms such as sweating, increased heart rate, nausea, vomiting, and others. Above all, the sufferer experiences thoughts they can’t control. But why does it appear and how can we deal with it?

Anxiety and nighttime anxiety

Nighttime anxiety is common.
The symptoms of nocturnal anxiety are multiple.

Nocturnal anxiety appears during the night, either when we go to bed or in the middle of the night. However, first of all, we need to talk about what anxiety actually is.

Anxiety is an adaptive emotion accompanied by a characteristic physiological state, which appears when we expose ourselves to a threat or imminent danger. In these cases, our body prepares to act, and either flees or fights.

It’s a very primitive ancestral mechanism that helped our ancestors to survive. But is it still a useful emotion?

Dysfunctional anxiety

When anxiety appears without apparent cause (or for an “unjustified” cause), then we refer to it as maladaptive or dysfunctional anxiety. We could say that, at present, this is the most frequent type of anxiety in 21st-century society, and especially in cities.

Why is this? Because, in general, in our urban environment we don’t have to expose ourselves to great threats to our physical integrity. In other words, we’re talking about anxiety that arises for causes other than a threat to one’s life.

Anxiety: a global problem

In fact, in 2006, according to the World Health Organization (Can Psych Assoc, 2006), anxiety disorders were the most common mental disorders in primary care services worldwide.

In 2005, within the adult population, the prevalence of anxiety disorders was 12% (WHO, 2005). Currently, the annual prevalence of generalized anxiety is 3%, and the global prevalence is 5% in the population.

Why do we suffer from anxiety?

Quite often, this maladaptive or dysfunctional anxiety appears as a result of our thoughts or worries.

In fact, in most cases, maladaptive anxiety appears due to thoughts that focus on the future (things that haven’t happened yet, but which we expect to happen).

However, there may be other causes behind this physiological and emotional alteration (and we include night anxiety here).

Night anxiety: anxiety at bedtime or during the night

Nighttime anxiety can appear both when we go to bed and also during the night (when we wake up in the middle of the night, for example). In these cases, and when it occurs at bedtime, the person has great difficulty falling asleep (insomnia).

This is often due to those very thoughts and worries, and, as a result, the person can’t sleep. On the other hand, when nighttime anxiety appears in the middle of the night, it may be due to a nocturnal panic attack or another type of anxiety (generalized anxiety, for example).

In extreme cases, night anxiety can keep the subject awake all night. Beyond the inability to sleep, or waking up with anxiety in the middle of the night, other physiological, behavioral, and psychological symptoms may appear.

Causes of nighttime anxiety

The causes of night anxiety can be multiple, and, in fact, we’ve already seen some of them. The most common ones are:

Thoughts focused on the future

Some experts affirm that anxiety is born by thinking excessively about the future, and that depression is caused by excessively thinking about the past. They’re referring to the types of thoughts the person has, and, with anxiety, they’re invariably focused on the future.

This anticipation of things that may happen (which are almost always negative events) can cause nocturnal anxiety. Thoughts like: “I don’t know how things are going to go tomorrow“, “The future’s so uncertain“, and “I don’t know what’s going to happen.

And, above all, we start having thoughts about what we should be doing tomorrow, which invade our heads just when we’re going to bed. These thoughts just go round and round and are often nonsensical.

Negative thoughts and worries

Due to these thoughts focused on the future, nighttime anxiety can also appear because of these worries and negative thoughts that go round and round in our heads.

These negative thoughts seem to attack us just when we’re about to go to bed and they activate our minds and keep us awake. For this reason, anxiety and insomnia strike and we may find it very difficult to fall asleep.

Anxiety disorders

Suffering from a basic anxiety disorder can also cause night anxiety. Among them, the most common is generalized anxiety disorder (GAD).

This disorder is characterized by the appearance of disproportionate, persistent worry or anxiety about certain issues.

Thus, the person with GAD overthinks their plans and thinks of all the worst possible outcomes, perceiving situations and events as threatening (even when they aren’t). They also have difficulty dealing with situations of uncertainty, etc.

Other causes

Sleep disturbances can also be one of the causes of night anxiety (as well as one of its consequences). We’re talking here about insomnia, night terrors, nightmares, restless legs syndrome…

Consequences

The consequences of night anxiety are multiple. The main one is insomnia. When suffering from anxiety, the person may have great difficulty falling asleep (onset insomnia) or maintaining it (maintenance insomnia).

In this second case, the subject wakes up repeatedly during the night, or can no longer fall asleep after waking up. On the other hand, insomnia can also be final insomnia (when the person wakes up early, much sooner than they would like, and can no longer go back to sleep).

Interference in our life

Night anxiety can also cause other sleep and wake disturbances (for example, frequent awakenings, nightmares, night terrors…). Thus, when the person feels anxious, they may end up suffering a decrease in the quantity and quality of their sleep hours.

This leads to other effects, such as lower work or academic performance, irritability, worry, discomfort, tiredness, fatigue, etc. In short, it greatly reduces our quality of life and our mental health.

How to overcome it

Nighttime anxiety may require therapy.
Mental therapy is always a valid option in these cases.

If we suffer from an anxiety disorder, be it nocturnal anxiety or of another type, the best thing we can do is to seek professional help (especially if this anxiety is recurrent or has become chronic). A mental health professional will help us manage that anxiety (or anxiety disorder) with specific treatments for it.

The most effective and widely-used treatments for anxiety are relaxation and/or breathing techniques and cognitive therapy. Through this latter, the expert will work with the patient on their thoughts. They’ll use strategies that are useful in order to combat negative thoughts and transform them into more realistic and functional ones.

From cognitive therapy (and also from cognitive-behavioral therapy) the hope is that, when working on a person’s thoughts, this will have a positive impact on the person’s emotions, behaviors, and attitudes. In anxiety, this is of great importance.

Measures to prevent and combat nighttime anxiety

Beyond therapy, we find some measures or strategies that can be good for us when managing night anxiety:

  • Stopping your thoughts: This is applied to ruminant or invasive thoughts, in order to stop them.
  • Sleep hygiene: This includes a series of measures to promote good quality rest.
  • Practicing meditation or mindfulness : These techniques can go very far in reducing the levels of activation in our bodies just when we go to bed.
  • Relaxation or breathing techniques: These are very effective, like the previous ones, in reducing the levels of activation (and even reducing the flow of anxious thoughts).
  • Having healthy lifestyle habits: Do exercise (but not just before going to sleep), eat a balanced diet, reduce the consumption of stimulants, follow certain routines.

Anxiety shouldn’t be ignored

Suffering from night anxiety can negatively interfere with our day-to-day life, because it prevents us from resting well. It also causes us discomfort at night, which is when it appears. If you feel that you could be suffering from this type of anxiety, then don’t hesitate to ask for professional help.

A good professional will work with you to understand the causes of this anxiety and to combat them. In addition, they can advise and accompany you as you seek to fight this symptom. You’ll soon see that you’ll begin to recover your personal well-being.

  • American Psychiatric Association –APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid: Panamericana.
  • Caballo (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos. Vol. 1 y 2. Madrid. Siglo XXI.
  • Carrillo-Mora P, et al. Trastornos del sueño: ¿qué son y cuáles son sus consecuencias? Revista de la Facultad de Medicina de la UNAM, 61(1): 6-20.
  • Marín H, et al. Trastornos del sueño, salud y calidad de vida: una perspectiva desde la medicina comportamental del sueño. Suma Psicológica, 15(1): 217-239.
  • Vázquez, C., Hervás, G., Rahona, J. J., & Gómez, D. (2009). Bienestar psicológico y salud: Aportaciones desde la Psicología Positiva. Anuario de Psicología Clínica y de la Salud5: 15-28.